Sunday, 6 March 2011

Healthy Debate

The NHS always gets people going. It's an emotive subject where everyone seems to be able to give good examples and bad examples of care but basically the majority of people have no desire to see it become an insurance based system. But whilst we're here, let's not kid ourselves that National Insurance is a hypothicated tax. It is an employment tax which goes into the general taxation fund. the NHS is funded by general taxation.

As examples of treatment I have two cases:

A 63 year old man was admitted to hospital having suffered a sudden stroke. A known alcoholic and prolific smoker with no family in attendance and it being late at night, he was not treated by doctors as a priority when admitted and was left overnight to wait for the duty consultant. He went into a coma. The family arrived next morning after traveling 150 miles to discover that he had just been shunted into a ward on admission. The doctors had not administered the appropriate medicine or care that is essential in the early treatment of a stroke and later one of his daughters was taken to one side and told that the best thing that could happen to him would be for him to die - sensitivity awareness not apparently part of the training. At the same hospital was a naval medical team who told the family that the hospital should have called them to attend. Over the road was a private hospital with state of the art equipment that he had attended whilst covered by his employer's health insurance. Unfortunately it had been several years since he was declared unfit to work and was on incapacity benefit. He died two weeks after being admitted.

A 66 year old woman was diagnosed with breast cancer and treated at her local hospital. It was caught at an early stage by her GP referred in a matter of days and a belts and braces treatment of surgery and chemotherapy was undertaken. The first surgery was only partially successful at removing all growths and a second operation was required. During treatment the chemotherapy drugs caused a heart problem which required further surgery and a stent. During the course of treatment the hospital was closed and transferred to another doubling the journey time and quadrupling the cost of attendance as she was deemed well enough to not require ambulance travel despite the drugs making her weak and tired and not capable of walking any significant distance. There was no financial help available to cover the travel costs despite being a pensioner with no savings of note. She has made a full recovery from the cancer but is now on constant medication to cope with her heart problems.

These aren't some abstract examples. They are my Mum and Dad both treated during Labour's "golden years" of massive investment. I'm not using them as examples to knock the NHS or indeed Labour (that comes later). They are simply real world examples that show that the NHS provides a service that we will all rely on one way or another. It is also not perfect and is unlikely to be.

However, the NHS is the jewel in our nation's crown. [Yes, I'm a reluctant monarchist... President Cowell by phone-in vote is a scary thought, You think I'm being alarmist? All I'll say to that is: Boris Johnson.] The principles on which the NHS is run are undoubtedly held by all by a few in this country and treatment according to need rather than ability to pay is a fundamental cornerstone of the service and a national touchstone. However, to think that the current system is fit for purpose and should be protected from change at any cost is plain stupidity.

It's a fair enough to raise concerns and fight against short-sighted decisions, but it is not enough to shout "fire" and point the finger without making the case for an alternative. It is bust, not because of principle but becuase of a demographic timebomb. Nor is is sufficient to rail against the private sector.  What needs to stop are the riduculous print your own money PFI contracts being handed out by successive governements and the end of guarenteed profits to private providers. They need to work for them.

Once upon a time the NHS ran its own computer centres, with its own staff. So where were the unions when Labour proposed spending £7bn on a privatised computer system funded using PFI? They seem all to ready to spread scare stories now but were remarkably supine when Labour were trying to cut costs?

The problem with that computer system was that it was a centrally determined and specified piece of snake oil as a result of paying too many consultants. I worked for Fujitsu Services who ran the southern cluster. Our head of the project was sacked when he dared mention in public that it wouldn't work. Everyone in the computer business knew it would be a waste of money but a lucrative waste of money for them. This was confirmed when the PFI contractors dream of constantly changing requirements and the addition of local changes to the system meant that the 'partners' could get the open chequebook out. This was not the fault of private enterprise, it was the fault of a government that didn't know what it wanted and had no way of telling when it had got what it thought it had asked for, The reality is that proper funding for local systems would have given a better return on investment with any (smaller) national programme concentrating on interfaces. The crucial part here is the failure was because of a disregard for local requirements and forcing a top down design on the PCTs.

I don't know if the current proposed changes will work. I also don't know that they won't. I do know however that letting health expenditure continue on its current course will bankrupt the country. Some of the proposals, like changes to the blood donor service, make me queasy but dental services were effectively privatised and eye care taken out of the universal system decades ago. No government since those changes has attempted to restore them to free at the point of use. In any case, prescriptions aren't free and dispensed mainly by the private sector through Boots and Lloyds The Chemist.

Labour's current dogma of "Public good. Private bad" is not evident in their track record which has been to privatise services by calling it something else.

The core Conservative belief in privatising services is still there but tempered by the knowledge that any attempt to construct an insurance based system will be electorally disasterous.

The public on the other hand are not that dogmatic. They want treatment free at the point of use. When working for Fujitsu, I asked to be opted out of the private health scheme they ran as a matter of principle but I wouldn't have minded one little bit if the NHS hospital had driven my Dad across the road for treatment.

The principle of allowing the money to follow the patient is the right one and whilst I have reservations about some of the other proposals, that is what allowing GPs to direct funding of services will do.

1 comment:

Johan said...

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